Clinical Significance of IgG4 Serum Concentration in Graves’ Disease

Olejarz, Michal; Szczepanek-Parulska, Ewelina; Krygier, Aleksandra; Wrotkowska, Elzbieta; Sawicka-Gutaj, Nadia; Ruchala, Marek

Clinical Significance of IgG4 Serum Concentration in Graves’ Disease

Archivum Immunologiae et Therapiae Experimentalis

Volume 72 (2024): Issue 1 (January 2024)

By:

Michal Olejarz, Ewelina Szczepanek-Parulska, Aleksandra Krygier, Elzbieta Wrotkowska, Nadia Sawicka-Gutaj and Marek Ruchala

Open Access

|Jul 2024

Figures & Tables

Flowchart displaying the composition of the studied group. GD, Graves’ disease; GO, Graves’ orbitopathy.

Boxplots comparing IgG4 serum concentration between GD without orbitopathy, moderate-to-severe GO, and the control group. GD, Graves’ disease; GO, Graves’ orbitopathy; IgG4, Immunoglobulin G4.

The ROC curve of IgG4 as a diagnostic tool for diagnosing moderate-to-severe GO. The optimal cut-off value determined by the highest Youden index was 49 mg/dL. At this cut-off value, the AUC was 0.851 (P < 0.001), negative predictive value was 100%, positive predictive value 48%, sensitivity 100%, and specificity 73%. AUC, area under the curve; GO, Graves’ orbitopathy; IgG4, Immunoglobulin G4; ROC, receiver operating characteristic.

Comparison of IgG, IgG4, and other biochemical features between hyperthyroid and euthyroid patients with GD

	Hyperthyroid GD (N = 32)	Euthyroid GD (N = 28)	P-value
IgG4 (mg/dL)	33 (23.78; 58.3)	52.4 (29.45; 95.6)	0.061
Total IgG (g/L)	11.72 (10.88; 13.09)	10.65 (9.77; 12.34)	0.098
TSH (μU/mL)	0.01 (0.01; 0.01)	1.55 (0.81; 2.25)	<0.001
fT3 (pmol/L)	25.72 (17.35; 31.95)	4.72 (4.44; 5.23)	<0.001
fT4 (pmol/L)	48.91 (38.08; 79.9)	15.14 (13.09; 16.01)	<0.001
TRAb (IU/I)	13.23 (6.43; 23.31)	2.09 (0.9; 3.98)	<0.001
TPOAb (IU/mL)	246 (59.75; 410.75)	63 (27; 147.25)	0.004
TgAb (IU/mL)	271 (35.25; 525.25)	20.5 (10.75; 164)	0.006
CRP (mg/dL)	1.15 (0.5; 2.53)	1.05 (0.48; 2.13)	0.953
Moderate-to-severe GO (% of patients)	9.38	32.14	0.050

Correlations of selected biochemical, hormonal, anthropometric, and ultrasound parameters with serum IgG4 and IgG levels

	IgG4	Total IgG
IgG4	–	ρ = 0.072, P = 0.586
Total IgG	ρ = 0.072, P = 0.586	–
Age (years)	ρ = (−)0.085, P = 0.517	R = (−)0.239, P = 0.066
CRP	ρ = (−)0.084, P = 0.523	ρ = (−)0.070, P = 0.594
TSH	ρ = 0.236, P = 0.070	ρ = (−)0.149, P = 0.258
fT3	ρ = (−)0.197, P = 0.131	ρ = 0.353, P = 0.006
fT4	ρ = (−)0.260, P = 0.045	ρ = 0.387, P = 0.002
TRAb	ρ = (−)0.270, P = 0.037	ρ = −0.032, P = 0.803
TPOAb	ρ = 0.052, P = 0.695	ρ = 0.130, P = 0.324
TgAb	ρ = 0.202, P = 0.685	ρ = 0.202, P = 0.122
Creatinine	ρ = 0.117, P = 0.373	ρ = 0.062, P = 0.637
ALT	ρ = (−)0.167, P = 0.202	ρ = 0.033, P = 0.800
AST	ρ = (−)0.047, P = 0.724	ρ = 0.103, P = 0.433
WBC	ρ = (−)0.0512, P = 0.697	R = (−)0.106, P = 0.421
RBC	ρ = 0.0852, P = 0.517	R = 0.219, P = 0.093
Hemoglobin	ρ = 0.033, P = 0.800	R = (−)0.133, P = 0.309
PLT	ρ = (−)0.033, R = 0.800	R = 0.142, P = 0.278
Thyroid volume	ρ = (−)0.233, P = 0.087	ρ = 0.145, P = 0.290
Intrathyroidal blood flow	ρ = (−)0.075, P = 0.594	ρ = 0.073, P = 0.603
Thyroid echogenicity	ρ = 0.077, P = 0.578	ρ = (−)0.153, P = 0.266
Number of thyroid nodules	ρ = (−)0.263, P = 0.054	ρ = (−)0.322, P = 0.117

Comparison of clinical, biochemical, and ultrasonographic features between high IgG4 and normal IgG4 GD

	GD patients with IgG4 serum concentration within normal range (N = 54)	GD patients with high IgG4 serum concentration (N = 6)	P-value
IgG4 (mg/dL)	33.9 (25.73; 67.8)	159.5 (143.78; 174.93)	<0.001
Total IgG (g/L)	11.25 (10.31; 12.4)	11.39 (10.69; 14.58)	0.411
Age (years)	39.96 ± 13.44	38.83 ± 11.84	0.844
Gender (% of males)	14 (25.93%)	1 (16.67%)	1
TSH (μIU/mL)	0.01 (0.01; 1.33)	1.54 (0.34; 1.94)	0.095
fT3 (pmol/L)	10.78 (4.74; 26.2)	6.06 (4.93; 6.76)	0.498
fT4 (pmol/L)	30.16 (15.4; 53.4)	15 (13.18; 18.33)	0.112
TRAb (IU/I)	6.03 (2.56; 16.82)	2.68 (1.54; 3.56)	0.078
TPOAb (IU/mL)	122.5 (31.25; 281)	218 (154.5; 280.75)	0.538
TgAb (IU/mL)	71 (13; 325)	246 (84.5; 554.5)	0.204
CRP (mg/dL)	6.03 (2.56; 16.82)	2.68 (1.54; 3.56)	0.408
Creatinine (mg/mL)	0.57 (0.44; 0.73)	0.62 (0.57; 0.73)	0.267
ALT (U/I)	23.5 (17.25; 32)	24.5 (17.25; 28.75)	0.970
AST (U/I)	21.5 (16; 25)	22.5 (20.25; 26.25)	0.330
WBC (×10³/μL)	6.46 ± 1.75	6.35 ± 2.3	0.878
RBC (×10⁶/μL)	4.71 ± 0.4	4.76 ± 0.18	0.802
Hemoglobin (g/mL)	13.55 (12.63; 14.38)	14.1 (13.6; 14.38)	0.810
PLT (×10³/μL)	4.71 ± 0.4	4.76 ± 0.18	0.802
Thyroid volume (cm³)	29.82 ± 21.83	19.35 ± 15.25	0.233
Intrathyroidal blood flow	1 (0; 2)	1 (0.25; 1.75)	0.707
Thyroid echogenicity	1 (1; 2)	1 (1; 1.75)	0.792
Presence of any thyroid nodule (% of patients)	36.73	16.67	0.653
Presence of multiple (≥3) thyroid nodules (% of patients)	18.37	0	0.574
Moderate-to-severe GO (% of patients)	14.81	66.67	0.012

DOI: https://doi.org/10.2478/aite-2024-0015 | Journal eISSN: 1661-4917

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Language: English

Submitted on: Mar 21, 2024

Accepted on: Jun 20, 2024

Published on: Jul 20, 2024

Published by: Hirszfeld Institute of Immunology and Experimental Therapy

In partnership with: Paradigm Publishing Services

Publication frequency: 1 times per year

Keywords:

IgG,

IgG4,

Related subjects:

Basic medical science,

Biochemistry,

Immunology,

Clinical medicine,

Clinical medicine, other,

Clinical chemistry

© 2024 Michal Olejarz, Ewelina Szczepanek-Parulska, Aleksandra Krygier, Elzbieta Wrotkowska, Nadia Sawicka-Gutaj, Marek Ruchala, published by Hirszfeld Institute of Immunology and Experimental Therapy
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

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Clinical Significance of IgG4 Serum Concentration in Graves’ Disease

Figures & Tables

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Fig 2.

Fig 3.

Comparison of IgG, IgG4, and other biochemical features between hyperthyroid and euthyroid patients with GD

Correlations of selected biochemical, hormonal, anthropometric, and ultrasound parameters with serum IgG4 and IgG levels

Comparison of clinical, biochemical, and ultrasonographic features between high IgG4 and normal IgG4 GD

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